Are trauma and orthopaedic consultant posts decreasing in frequency and increasing in subspecialisation?

Background: The needs of the population and changes to the configuration of the NHS affect the role of the Trauma & Orthopaedic (T&O) surgeon. This impacts training and the number of consultant posts available at Certificate of Completion of Training. Aim of this study was to review advertised T&O Consultant posts and determine the trends in frequency and sub-specialisation requirements between 2011 and 2020 to assess the perceived reduction in advertised posts and increasing subspecialisation, also looking at the impact to the NHS.

Methods: 451 volumes of the BMJ were reviewed over Jan 2011 - April 2020. The total number of jobs advertised were recorded. Additionally, for each post, sub-specialisation, region and substantive or locum tenure were recorded. Statistical analysis was conducted with both negative binomial repeated measure and binomial repeated measure with multi-level structures along with GARCH model.

Results: 1141 jobs were advertised. There has been a decreasing trend in the total number of advertised posts of 13% per annum. Proportion of specialty jobs remain constant yearly. Posts listing Trauma as a subspeciality clearly decreased after 2012. Decreases were present in Northwest region and Scotland in number of posts. There has also been an increasing trend of advertisement of substantive posts, with locum posts forming less than 13% of total advertisements.

Conclusions: We found no significant increase in job specialisation contrary to previous literature. Overall, total number of Consultant posts in T&O decreased over this time period, especially in the North West region and Scotland. The needs of the population and NHS services need to be considered.